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General NPI Number Information
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NPI Number | 1851441869
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Entity Type | Individual
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Provider Name | SHANG XU O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 120 CROSSGATES MALL ROAD #L104
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City | ALBANY
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State | NY
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Zip | 12203-5385
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Country | US
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Telephone | 518-869-8578
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Fax |
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Provider Business Mailing Address
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Address Line | 13 ELAINE CT
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City | LATHAM
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State | NY
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Zip | 12110-3726
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Country | US
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Telephone | 518-785-7376
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Fax | 518-785-7376
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV006771-1
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License Number State | NY
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